Sarah Pakzad

Men-centered Approaches for Primary and Secondary Prevention of HIV/ AIDS: A Scoping Review of Effective Interventions

Approximately 65,000 people live with HIV/AIDS (PLWHA) in Canada and around 82% of declared cases (52,932 cases) of HIV and AIDS are men. Without evidence-based specific interventions, HIV will continue to spread. This scoping review aims to identify evidence on best practice programs for sexual and reproductive health promotion (i.e. HIV/AIDS) targeting men, and to document the best channels for reaching men. English and French language literature indexed in relevant electronic databases was systematically searched. This was complemented by a manual search through five periodicals specializing in mens health. A total of 6608 articles were identified and 39 articles that met all inclusion and exclusion criteria were retained in the synthesis. Three reviewers independently extracted information on: health topic (i.e. HIV/AIDS), design of services (structure and resources), modes of delivery, content of intervention and main outcomes. The preventive practices with the strongest supportive evidence included, just in time information available through electronic channels (website or cell phone). Interventions designed for men only, showed significantly greater effectiveness compared to interventions targeting both men and women. We derived practical recommendations to design an integrated evidence-based preventive intervention targeting men.

Effect of sumac spice, Turkish coffee and yerba mate tea on the postprandial glycemic response to Lebanese mankoucheh

Purpose – The aim of this study was to evaluate the individual effect of sumac (S), Turkish coffee (C) and yerba mate tea (Y) on the postprandial glycemic response to Lebanese mankoucheh, a common breakfast item in the Lebanese culture, and to determine the glycemic index (GI) of this food. S, C and Y are typical constituents of Lebanese meals. They may influence the postprandial glycemic response to carbohydrate-rich foods, but this has not been studied to date. Design/methodology/approach – Twelve healthy normoglycemic adults consumed on separate days the following test meals: mankoucheh without S (M) with water (control meal); M prepared with single or double doses of S (S1 and S2) with water; M with 60 or 120 mL of unsweetened C; or M with 100 or 200 mL of unsweetened Y. Meals were prepared according to standardized recipes containing 50 g of available carbohydrates. Capillary blood glucose measures were taken at fast and six times after meal ingestion over a two hour period. The GI of mankoucheh was ...

Accès au diagnostic précoce de démence au Nouveau-Brunswick : perceptions d’usagers potentiels de services selon la langue et le milieu de vie

RésuméObjectifsLe diagnostic précoce de la démence (DPD) est crucial autant pour l’identification des causes réversibles que pour la mise en place rapide d’interventions de prévention secondaire et de prise en charge thérapeutique. Cette étude explore la perception d’aînés du Nouveau-Brunswick concernant l’accessibilité, la disponibilité et la satisfaction des services de DPD, en tenant compte de leur langue d’usage et de leur milieu de vie (urbain ou rural).MéthodeQuestionnaire auto-administré explorant les perceptions d’aînés francophones et anglophones de régions rurales et urbaines du Nouveau-Brunswick concernant les services de DPD. Des analyses univariées et bivariées ont été réalisées.RésultatsParmi les 157 participants âgés de 65 ans et plus ayant répondu au questionnaire et dont les données ont été analysées, 84 déclarent être principalement francophones et 72 parmi eux vivent en milieu rural. Les analyses bivariées suggèrent que les groupes linguistiques étudiés sont comparables en ce qui concerne leurs perceptions de la disponibilité, l’accès et la satisfaction des services de DPD. Toutefois, l’introduction de la dimension géographique montre des disparités intragroupes et intergroupes linguistiques, notamment en ce qui a trait à l’information relative au type de services disponibles dans la région.ConclusionCes résultats suggèrent que les aînés vivant en milieu rural au Nouveau-Brunswick représentent un groupe particulièrement vulnérable ayant une perception d’accès limité aux services de DPD dans leur région.AbstractObjectivesThe early diagnosis of dementia (EDD) enables the identification of reversible causes of dementia and allows the timely implementation of secondary preventive and therapeutic interventions. This study explores New Brunswick seniors’ perceptions of the accessibility and availability of EDD services as well as their satisfaction with them while taking into account their language of use and place of residence (urban or rural).MethodSelf-administered survey exploring perceptions of EDD services in Francophone and Anglophone seniors from rural and urban areas of New Brunswick. Univariate and bivariate analyses were carried out.ResultsOf the 157 participants aged 65 years and over who filled out the survey and whose data were analyzed, 84 identified as Francophone, 72 of whom lived in rural areas. Bivariate analyses showed that linguistic groups were comparable with regard to their perceptions of the availability, access to, and satisfaction with EDD services. However, when taking the geographic dimension into account, linguistic intergroup and intragroup disparities were observed, notably in the areas pertaining to the type of services available in the area.ConclusionsThese results suggest that seniors who live in rural areas of New Brunswick are a particularly vulnerable group with perceived limited access to EDD services in their area.

TOWARD DEVELOPING AND VALIDATING A NOVEL COGNITIVE FRAILTY INDEX

Background:Subjective cognitive decline (SCD) could be a potential harbinger of AD. People with SCD often experience word-finding problems, but these are difficult to objectifywith neuropsychological or linguistic assessments and it is unknown whether they are related to underlying Alzheimer pathology. We aim to investigate whether semantic complexity, determined from spontaneous speech is reduced in SCD patients with preclinical AD.Methods:We included 61 cognitively normal patients with SCD (age 6468, 41% female, MMSE 2961), available amyloid status, and spontaneous speech recordings (minimum 300 words) from the ongoing SCIENCe cohort. Spontaneous speech was recorded using descriptions of the cookie theft figure, an abstract painting and an open-ended question (describe your regular Sunday). Speech recordings were transcribed verbatim and the following a priori defined linguistic parameters were extracted using the computational linguistics package software package T-scan and in-house developed python scripts: abstract nouns (proportion), content words (1000 most frequent), nouns referring to complex human characteristics (density), nouns referring to concrete events (density), lemma (frequency), content words (density), Type Token Ratio content words (TTR), D-level, word length and fillers (frequency). Amyloid positivity (yes/no) was determined based on visual reading of florbetapir or florbetaben PET scans (n1⁄453), or AB1-42 CSF (n1⁄48). The effects of amyloid (independent variable) on the different measures of language complexity (dependent variable) were investigated using linear regression adjusted for education and age. Results: Twenty (33%) SCD patients were amyloid positive. Age, education, gender, MMSE and depressive symptoms were comparable between groups. Adjusted for age and education, amyloid positivity was related to less use of specific words referring to human characteristics (stdb1⁄4 -.31, p1⁄4.02), and less use of concrete nouns referring events (stdb1⁄4 -.29, p1⁄4.03). There were no differences between groups on other types of non-specific words, syntactic complexity, word length, or information density. Conclusions:Preclinical AD in SCDwas associatedwith a lower proportion of specificwords, but not to estimates of syntactic complexity or information density. Spontaneous speech recordings could be a promising way to reveal subtle Alzheimerrelated language deficiencies in cognitively normal individuals.

PRIMARY CARE INITIATIVES FOR COMPLEX NEUROCOGNITIVE DISORDER CARE: PROTOCOL FOR AN INNOVATIVE MIXED-METHODS DESIGN

Background:Early referral to cognitive specialty clinics is recommended in most European practice guidelines. In the US, where most cognitive problems are managed in primary care, the role of cognitive specialty clinics is controversial and referrals are inconsistent and often delayed. Specialists without a dementia focus may not offer family education and support.Methods:We used electronic medical records from 2013 to compare outcomes in 8887 patients age >65 in primary care community clinics and in 290 patients in our transdisciplinary cognitive specialty clinic. We examined patient-centered outcomes a care partner panel identified as important, and health system outcomes a health care leadership panel judged sufficient to change practice. The difference in dichotomous outcomes was tested with Chi-square tests and count outcomes were comparedwith the exact rate ratio test assuming Poisson distribution. Results:Patients with cognitive impairment weremuchmore likely to achieve patient-centered outcomes when seen by the cognitive specialty team than only primary care. Family support from a social worker was documented in 77% vs 4.2%, use of drugs classified as inappropriate on the Beer’s list was 9% vs. 36%, and referral for driving evaluation was 30% vs. 0.8% (all p <0.001). Only documented advanced directives were not significantly different, 27% vs. 24% (p 1⁄4 0.43). Emergency visit rate was lower (0.13 vs. 0.20, p 1⁄4 0.03), and there was a trend toward better diabetes control (p1⁄40.06) with specialty care. Patients with both diabetes and cognitive impairment achieved even lower rates of patient-oriented outcomes in primary care: family support was 0.35% vs. 72% and completion of advanced directives was 12% vs. 23%, (both p <0.001). Conclusions: Cognitive specialty teams are more likely to achieve patient-centered and health system outcomes than primary care. Current strategies in primary care fail to identify as many patients with cognitive impairment as expected, so considerable opportunity for improvement remains. Cognitive impairment may contribute to poor control of diabetes and diabetes may interfere with outcomes in primary care setting because attention is distracted away from cognitive care. A pragmatic, prospective, randomized trial would address limitations of this retrospective, observational study.

HELP-SEEKING FOR SUBJECTIVE MEMORY COMPLAINTS (SMC) IN OLDER ADULTS IN NEW BRUNSWICK

available to neurologists. Based on previous recommendations for classifying PD-MCI (Litvan et al., 2012), participants in this study were classified as PD-MCI (n1⁄465) if MoCA score was <26 or if they scored 1 standard deviation below the normative mean in two or more domains. The remaining 117 participants were classified as normal. The sensitivity and specificity for the clinical detection of PD-MCI was determined by examining the clinical determination of cognitive status compared to participants classified as normal or PD-MCI based on neuropsychological test performance. Results: Overall accuracy for the clinical detection of PD-MCI participants was 63.4%; while clinical determination was highly specific (88.0%), sensitivity was poor, as only 24.6% of individuals demonstrating impairment on neuropsychological testing were clinically identified as PD-MCI. Only 30% of neurologists endorsed utilizing cognitive data. Reported use did not affect classification accuracy, c(1,182)1⁄40.01, p1⁄4.523. In cases of clinically determined normal cognition, clinicians were 90-100% confident of their decision 92.8% of the time. In cases where PD-MCI was diagnosed, a high level of confidence was endorsed 60.0% of the time c(1,182)1⁄424.36, p<.001. Conclusions:The sensitivity of clinical judgment in identifying MCI in PD is low. PD is a subcortical disease process where language and memory are less impacted than other cognitive domains. Therefore, identifying MCI based upon clinical interview alone appears to be insufficient. In cases where cognitive impairment is detected, diagnostic confidence is lower than in cases where impairment is not suspected. In both clinical and research settings, the inclusion of objective cognitive test data interpreted by a trained neuropsychologist may decrease rates of false negative findings.